What Will Be Required in the Future in Administration of Venezuelan Health?

In addition to the obvious shipments of medicines for a myriad of conditions, large administrative changes will be needed to restore the Venezuelan health system.

The current situation involves an extremely “horizontal” system based on primary health clinics – Barrio Adentro.  The Chavistas have also placed many political appointees in place of trained and educated specialists in the various health fields.  Many specialists and other educated people have emigrated and are no longer in Venezuela.

How can Venezuela’s health system recover from this situation?  The recovery will obviously be difficult, but a few measures for a new government to take are clear:

  • In hiring new personnel, screen out loyal Chavistas and personnel from the Maduro administration.
  • Hire based on actual qualifications.
  • Chavismo has left an unfortunate unproductive and negative attitude among many people.  In hiring, seek people who have positive and productive mindsets.
  • Cooperate with international organizations that will probably be present in the recovery.
  • Cooperate with business and industry, while also maintaining a regulatory regime to prevent the high health costs that are typical of the United States. Consider a model more similar to the health systems in other Latin American countries or similar to the pre-Chavismo system in Venezuela.
  • Consider restoring some of the now-disbanded former structures that were successful in past years.  I am thinking especially of the MSAS (Ministerio de Sanidad y Asistencia Social) that was once led by Arnoldo Gabaldón.  The MSAS was fused with another ministry (Ministry of the Family) in 1999 and underwent a process of decentralization .
  • The basic result of this administrative change was that the public health function of the MSAS was diluted and two things happened:
    • Change in focus toward social programs and away from actual public health programs.
    • Extreme decentralization and focus on primary health care (Barrio Adentro) and away from any vertical, nationwide efforts.  As an example, vaccination programs have suffered greatly in the past 18 years.
  • The disastrous result of these changes in Venezuela’s health administration is now visible.  Epidemics of measles, diphtheria, malaria, and massive medicine shortages.

 

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Consciousness-Raising About Venezuela

Over the past year, the crisis in Venezuela has grown in scope.

A year ago, for me, a year ago, the exodus from Venezuela and problems inside Venezuela were a reading topic.  The vector-borne disease situation in Venezuela revived my interest in the field in which I did my degree – Entomology.

Entomology had been largely dormant for me because of some rather bitter although not extreme experiences from the early 1990s that were related to Caregiving for my mother and the conflict between that and my work in Entomology.  My point here is not to discuss those experiences, other than to say that the recent report from the National Academy of Sciences has largely vindicated my feelings about these experiences.

For several months, I took actions both personally and on social media to promote and defend the rights of Caregivers.  As the number of actions I took increased, I felt more reconciliation with my former career.  The capstone of that reconciliation was the NAS report mentioned above.

I sure am glad now that I did this!!  The Venezuelan exodus has now become a topic of daily conversation.  Today, I heard from a good friend about a group of nine Venezuelans he saw by a rural roadside.  They were trying to catch a ride to Ecuador.

The situation now affects travel plans.  It makes formerly-easy border crossings in Latin America difficult.

And, I know that Entomology, or perhaps the lack of expertise thereof, is a piece in the puzzle in the crisis.  Of course, the overall roots of Venezuela’s problems are political.

Nevertheless, the following question needs to be asked:

How did the country with one of the world’s best vector-borne disease control programs in the 1930s-1970s fall so far?  What are the proximate causes?

And, interest in that question is why I registered a new domain name today, vzvectors.com.

 

 

 

 

On the Road Again

During the upcoming week, I will be riding the buses once again in southern Colombia. I have a paperwork-related errand that I need to accomplish in Cali.

Meanwhile, I will be observing and talking with the people whom I meet on the way.

 

Ruth Sponsler

M.S. Entomology

406,000 Cases

That thing about the 400,000 cases mentioned above? It’s been validated by the World Health Organization.

That number has been widely reported, including by Reuters, Al Jazeera, and Crux.

Personal Note:

I recently met some Venezuelan refugees. I did not take pictures, because I respect people’s right to privacy, especially when they come from a dictatorship.  The people I met were from Caracas, Miranda, and Trujillo, which are locations affected by food and medicine shortages, but not by malaria.

400,000 Cases – Was that Spring Break?? No, it Wasn’t.

 

Four hundred thousand cases !!!!  400,000.

Four hundred thousand cases would would probably quench the thirst of Cancun during Spring Break. The beer distributors are competing for awards!!

It’s hot in Cancun. Everyone drinks something…

Coca Cola and Pepsi come in cases, too. Those count, too!!  Especially _real_ Coca Cola from Mexico made with cane sugar and not HFCS.  (But Fanta, gag, doesn’t count).

Bottled water comes in cases, too.

Coffee is awesome but it doesn’t come in cases.

Doggone. That 400,000 number was cases of malaria in Bolivar…..not beer and soda in Cancun!

 

 

 

 

 

Long Waits at Rumichaca

I currently live only a couple of hours away from the border between Ecuador and Colombia at Rumichaca.

Since late last year, the number of Venezuelans crossing the border at Rumichaca has risen from a couple of hundred per day to a couple of thousand per day.

Almost all of the traffic is southward. Venezuelans leave Venezuela at Cúcata, ride a bus for a day and a half across Colombia, leave Colombia, and enter Ecuador on their way to Peru or Chile.  All this is usually in search of work and a better life.

Recent reports indicate waits of up to eight hours to stamp out of Colombia and into Ecuador.

What is the public health context of this?  The Venezuelans are not only fleeing violence in Venezuela, but are also fleeing an extraordinarily deteriorated health system in which there are enormous medicine shortages combined with epidemics of measles, diptheria, and hundreds of thousands of cases of malaria per year, many of those untreated.

More about all of this in future posts.

First Case of Measles in Ecuador Since 2011 – ex. Venezuela

During the last four years, I have crossed the border between Colombia and Ecuador at Rumichaca a number of times. That border is located at 2700m (9200 ft) altitude in the Andes and thus has a temperate climate.

On March 27th, a child from Venezuela crossed the border at Rumichaca. He had travelled from Caracas through Colombia to Rumichaca during the incubation period for measles.  He probably rode a bus.

A day or two later, in Quito, the child developed fever, cough, and probably a rash. The child was diagnosed with measles and received medical treatment in Quito.

This is the first case of measles diagnosed in Ecuador since 2011. During recent months, there have been five cases of measles in Colombia, all imported from Venezuela.

In 2016, the region of the Americas was declared to have eliminated measles, although several hundred thousand cases of measles occur annually in Africa, Asia and Europe. That proclamation of measles elimination in the Americas was obviously made too soon.

The epidemic of measles in Venezuela is caused by governmental indifference to providing vaccinations. This cause is somewhat different than the vaccine refusers who are contributing to spread of measles in North America and Europe.